FDA Prior Notice Assistance Form

International samples submitted to Dairyland require FDA Prior Notice.  To submit international samples, please complete the following form.  Once submitted, within 24 hours a Dairyland representative will return all of the necessary paperwork for importing a feed sample.
 

* Required field

* Company name
First name
Last name
Dairyland Account Number or Name
* Email Address
* Phone Number
Fax Number
* Complete Address
* Country in which material was produced
* Country containing business location of shipper
* Country from which article is being shipped
SHIPPING INFORMATION
* Number of Packages
* Courier
* Shipping Date
Tracking Number
* Would you like Dairyland to generate a commercial invoice and provide UPS Shipment of this sample. (cost will be added to your invoice)	Yes  No
SAMPLE TYPE 1
* Complete sample type description
* Number of samples
* Estimated weight in ounces
SAMPLE TYPE 2
Complete sample type description
Number of samples
Estimated weight in ounces
SAMPLE TYPE 3
Complete sample type description
Number of samples
Estimated weight in ounces
SAMPLE TYPE 4
Complete sample type description
Number of samples
Estimated weight in ounces
SAMPLE TYPE 5
Complete sample type description
Number of samples
Estimated weight in ounces
Total Package Weight
Disclaimers
Submission of this form will be considered an electronic signature by the Name indicated on the top of this form. Dairyland Laboratories, Inc., will only submit a notice for animal feed (non-medicated) products, which do not contain animal-origin ingredients. The description needs to be specific, for example: hay, corn silage, small grain silage, haylage, grain, mixed feed, or soybeans. By submitting this form, I verify that this sample does not contain any animal by-products. I also verify that this information is true and correct to the best of my knowledge, and request Dairyland Laboratories Inc., of Arcadia, WI to submit a Prior Notice of Food Importation, to the FDA on my behalf, and agree to reimburse any U.S. Custom fees incurred by Dairyland Laboratories, Inc. Under 18 U.S.C. 1001, anyone who makes a materially false, fictitious, or fraudulent statement to the U.S. Government is subject to criminal penalties
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